Provider Demographics
NPI:1568996387
Name:ROACH, MARCELLA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:ELIZABETH
Last Name:ROACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:ELIZABETH
Other - Last Name:ELPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1921 KALORAMA RD NW
Mailing Address - Street 2:APT 104
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1417
Mailing Address - Country:US
Mailing Address - Phone:423-963-0360
Mailing Address - Fax:
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206
Practice Address - Country:US
Practice Address - Phone:703-769-8431
Practice Address - Fax:703-769-8437
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005724363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical